If ever you suspected that the ‘hard problem’ of consciousness was a recondite philosophical matter, of no significance in the real world, a recent piece in the NYT (discussed briefly by our old friend Steve Esser) should convince you otherwise.

It explains how Kanwaljeet Anand discovered that new-born babies were receiving surgery without anaesthetics, and goes on to discuss the evidence that fetal surgery, increasingly common, also causes pain responses in the unborn child.

Why would doctors be so callous? They don’t believe new-born children, let alone fetuses, feel any pain. When they operate on a new-born baby, there may be some reflexes, but there are no pain qualia – no pain is really being felt. So all they need to give in the way of drugs is a paralytic – something that makes the subject keep still during the operation, but has no effect on how it feels.

It seems to me that, although they may not be clearly aware of it, the doctors here are making important real world decisions on the basis of their philosophical beliefs about qualia. Quite bold beliefs too: they don’t believe the fetuses can be feeling pain because the brain, and in particular the cortex, is not yet wired up sufficiently for consciousness, and if you’re not conscious, you can’t have qualia.

It’s quite possible they are right, I suppose, but I think most people who have been through some of the philosophical arguments would doubt whether we can speak of these matters with such certainty, and would be inclined to err on the side of safety. To be honest, it’s a bit hard to shake the suspicion that the real reason fetuses don’t get anaesthetics is because fetuses don’t complain…

I think the real issue here is slightly different. Why was Anand concerned about the babies who were coming back to him after surgery, before he even knew they weren’t being anaesthetised? Because they were traumatised. Their systems had been flooded with hormones usually associated with pain, their breathing was poor, their blood sugar was out of order. When they were given anaesthetics, instead of just paralytics, they survived the operations in better health. There were medical reasons for avoiding the pain, not just subjective ones. The problem arose out of the fact that the surgeons and anaesthetists had got used to the idea that relief of subjective pain was all that mattered. So when they were dealing with patients who they judged incapable of subjective pain, they saw no reason to anaesthetise. They were, in fact, paying too much attention to the idea of qualia, and not enough to the physical, medical events which actually constitute pain even if your cortex isn’t working. (The passage in the NYT piece about people with hydranencephaly is a dreadful red herring, by the way: it just isn’t true that they have no cortex.)

True, there were other reasons for using anaesthetics in that particular case. But where do the doctors get their certainty that no pain is being felt? You can’t talk about your qualia if your cortex isn’t working, but since qualia are an utter mystery and separable in principle from the physical operation of the brain altogether, there’s no strong reason to think you’re not feeling them. We take winces and grimaces as good indicators of pain in normal people: how can we be sure it’s any different in fetuses? Is it just the talking that matters? Is an unreportable pain no pain at all? Surely not.

You say qualia are separable from the physical operation of the brain, but you don’t really believe that in any important way. You know quite well that brain events like the firing of certain neurons are what cause these sensations you misdescribe as ineffable qualia. If I hit you with a physical spade, you’ll feel pain qualia alright, however ’separable’ you think they are.

Let’s get a bit more philosophical here. Why is pain bad? Why is it to be avoided and minimised? There are several traditional answers — I’d say the following just about cover it.

It just is. Pain is just bad in its essential nature.

The moral rules agreed by our society enjoin us not to cause pain.

Ethics requires us to seek the greatest possible balance of pleasure over pain.

You wouldn’t want pain inflicted on you, so don’t inflict it on other people.

Witnessing or hearing about pain makes me feel bad.

Carelessness about pain is the beginning of a general callousness which might undermine our concern for others, without which we’re doomed.

The first doesn’t mean anything, if you ask me. The second might be right, but the established rules, judging by medical practice, seem to say fetal pain is something we don’t have to worry about. Social rules are negotiable, anyway, so there’s no final answer there. The third one, like the first one, just assumes pain is bad. The fourth is OK, but begs the question so far as fetuses are concerned, because we don’t know what I’d want done to me if I were a fetus. I might just want them to get on with the operation, unbothered by the apparent ‘pain’ I wasn’t actually feeling. Numbers five and six, if you ask me, get close to the real motivation here.

Got that? OK, now let’s revert to your question — why do the doctors behave like this, why do they torture babies? It’s not just, I suggest, that they don’t believe in fetal pain. The more crucial point is that they know fetuses don’t remember pain. There was a time, in the not-too-distant past, when some children, not just babies, were merely given curare before being operated on. Just like the new-born babies here, it paralysed them so the surgeon could get on with the job, but did nothing whatever to relieve the pain. Did the doctors think the children didn’t feel the pain? Well, there’s some talk about them thinking curare was aneasthetic, but that’s balderdash — they didn’t use it for adults. No, I believe they knew quite well the children were in pain, they just thought it didn’t matter because children don’t remember these things. Give ‘em an ice cream, they thought, and we’ll hear no more about it. (I’m not saying that’s necessarily correct, by the way).

In essence, the doctors implicitly agreed with me. There were no deep metaphysical or ethical reasons to avoid pain, and reciprocity never really worked, because there were always relevant differences between you and the person suffering the pain (unless you were fighting your twin brother, perhaps). You could always say; yeah, do as you would be done by, but if I were in the state that person’s in, I would want it done to me. So, the doctors rightly concluded, there were only two fundamental reasons to avoid causing pain; first, it upset people. As a result, our social rules were generally set to minimise it, and so second, the unnecessary infliction of pain would tend to have bad social effects, undermining the rules and generally risking a withdrawal of social consent. Pain which will never be remembered cannot upset us or have bad social consequences — so it doesn’t matter.

There’s more evidence that this is the established medical view. Besides paralysing and anaesthetising patients, doctors use drugs which specifically remove the memory. In some cases, drugs which remove the memory have been used instead of anaesthetics, just because in medical eyes, pain you don’t remember is the same as pain that never happened. It’s perfectly normal contemporary practice to use a mixture of true anaesthestics and amnestics.

So, to sum up, pain has three aspects: medical (the hormonal reaction, the changes in the body), psychological (we don’t like thinking about it), and social (we’ve agreed to outlaw pain, and erosion of that rule undermines society generally). And that’s all there is. The medical, psychological, and social aspects add up to what pain is: there’s no mystical component, no qualia.

That just seems mad to me – bonkers and almost diabolical. Surely you can see that the reason pain is bad is because it hurts? That’s all pain is – hurting.

You and your supposed doctor friends are a bit over-confident about your amnesia anyway, aren’t you? The NYT article reports evidence that pain experienced early on affects a child’s responses later. Do you really feel confident that agonising episodes early on — even in the womb — are not lurking in some damaging form in the subconscious of the child, or even the adult?

17 Comments

2. Ernie Kinsey says:

What about the idea that pain is an indication that an organism’s existence is threatened? Wouldn’t that be enough to cause pain to be avoided, and the subjective unpleasantness is the means by which the organism is moved to do things to reduce the pain?

3. Peter says:

They certainly seem as if they do, baby boy.

That seems entirely sensible, Ernie. The problem is in explaining how and why the subjective unpleasantness does its job, since it seems possible to imagine a robotic/zombie person who avoided painful situations without ever needing to feel actual pain.

6. Shankar says:

7. Shankar says:

What about the natural birthing process itself? If it is traumatic for the baby during that period, but all physiological and psychological effects are wiped away as though nothing happened, why does evolution care one way or the other? Evolution doesn’t care about such niceties as painless birth (either for mom or the baby), as long as it gets the job done, which is the survival of the species.

There we are – restored. Thanks for that, Shankar – and thanks to Norm at MLU.

I suppose it could be that pain during birth does have some lasting bad effect, which we don’t notice because we’ve all suffered it – up till now. Or maybe the ‘natural’ pain of birth is something we’re ready for, whereas being jabbed with a scalpel is a more upsetting business. But I think the balance of probability is that you’re right, and that fetal pain has no lasting effect.

You’re certainly right that evolution doesn’t care about pain that doesn’t threaten your survival. Think of teething, to keep up the baby theme.

9. Rodger Cunningham says:

Surely entire books have been written about the birth trauma, and entire psychological schools based on it? All highly dubious, and I’m probably showing my age by adverting to it, but Shankar’s comment seems to me to display amnesia of a different kind.

12. James says:

I think it is important to consider this in light of early childhood development, alluded to above. Psychologists tell us that the late fetal and early infant brains are gearing up for one thing: the assimilation of sensory stimulation for the purpose of building a subconscious construct upon which later conscious experience will hang (or float, if you like the iceberg model). Many think of the subconscious as: 1. pre-conscious experiences which the brain has “remembered”, but without the benefit of conscious narrative and thus unaccessible at that level and 2. conscious experiences suppressed below the level of conscious narrative and thus beyond its direct access and control. However you like it, it is no secret that the subconscious is profoundly important to the daily life of the adult. So, it is essentially irrelevant whether the late fetus or early infant “remembers” their pain as a toddler might (assuming they do not suppress it). Why, because the infant is “remembering” their pain in the only way an infant can, as a building block for later cognition. Though it could be argued that the adult is not the infant they once were, because they do not remember this experience, they nevertheless owe everything to that infant as the incubator of their present consciousness.

To maintain perspective, I must admit that late fetal/early infant trauma probably does not impact later life in the same way as that of a toddler, because at those different levels of development it is of a different kind (i.e. like the effect of using inferior materials to build a house verses smacking a house with a wrecking ball). However, it may impact the adult in a way we do not have direct access to and thus, one should not be careless about it. In the case of birth trauma, well, its just the way of things, like teething, losing teeth at age 6, joint pains and hormonal swings during adolescence, etc, etc. Nobody said being a biological organism was going to be easy. But, why make it worse out of ignorance and false assumptions?

14. bill says:

Most everyone confuses the human brain with the mind; they are completely separate entities. The physical body and brain are created through procreation, whereas the individual mind is created through the attachment of a name to the individual. This has been and can be proven by analyzing anyone’s name and describing their qualities of mind as well as experiences, etc.